Presenting author biography:

Susan Shepherd is Manager of the Toronto Drug Strategy Secretariat, which supports implementation of Toronto's drug strategy. She has 20 years policy experience with the City of Toronto in the areas of substance use and homelessness. Susan has presented widely on evidence-based approaches to reducing the harms of substance use.

Supervised Injection Services in Toronto: Mobilizing Support to Save Lives

Susan Shepherd, Shaun Hopkins, Angela Robertson, Lynne Raskin

As in other cities around the world, Toronto has seen a dramatic rise in drug overdose deaths. Between 2004 and 2014 there was a 77% increase in the reported number of people dying from overdose in Toronto – from 146 deaths in 2004 to 258 in 2014. Of particular concern is the role of opioids such as heroin and fentanyl in these deaths. Supervised injection services (SIS) are key to a comprehensive overdose prevention strategy by providing a safe and hygienic environment where people can inject pre-obtained drugs under supervision.

In Canada, SISs require federal approval to legally operate. The federal application process is onerous and involves municipal and provincial governments, health and enforcement stakeholders and community consultation. Toronto Public Health (The Works), Central Toronto-Queen West Community Health Centre and South Riverdale Community Health Centre collaborated on a coordinated and comprehensive implementation plan for SISs that are integrated into existing harm reduction services. The implementation plan incorporated learnings from other jurisdictions, and included innovative service design, stakeholder management, strategic communications, and an engaged and effective community consultation process that reflected the context and needs of Canada's largest urban centre.

The municipal-community partnership used in Toronto resulted in the development of an implementation plan that was comprehensive, strategic and effective. Despite the controversial nature of SIS, there was little public or political opposition, and media coverage was largely positive. This response is unusual as many cities encounter opposition, often by elected officials and community stakeholders. The three-site SIS proposal in Toronto received strong endorsement by both the Board of Health and City Council, and lessons learned could be applied to other communities.